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Maternal mortality in Chile.

Social, Economic, Cultural and Religious Context (1)

Chile's transition to a restored democracy began 15 years ago in 1990, and the coalition of political parties that opposed the military regime has been in power for three consecutive terms dating from that time. This period has witnessed the consolidation of a neoliberal model with global participation and notable macroeconomic achievements. Nevertheless, this economic growth has concentrated wealth in Chile and seriously delayed the achievement of a basic level of well-being for the general population. While a variety of social policies and targeted social spending have reduced the number of individuals living in poverty, the gap between rich and poor has widened enormously and made Chile one of the most inequitable countries in the region and the world.

Macroeconomic growth and stability have been accompanied by progressive deregulation and growing instability in the labor market with serious social consequences and the loss of workers' rights. The development model adopted by Chile also limits the role of the State, leading to a redefinition of rights that the State is supposed to guarantee, such as the right to health, education and social protection. In this context of profound social inequity, there is a clearly unequal distribution of opportunities, including citizens' opportunity to care for, maintain and recuperate their health.

This social inequity is compounded by the persistent problem of gender inequity. Women's participation in the workforce has increased but under precarious conditions that include higher unemployment and a major gap between the earnings of men and women. (2) Women's participation in political decision-making positions is minor, and there are no institutional mechanisms currently aimed at correcting their under-representation. (3) Violence against women is one way in which Chilean women's rights are violated on a daily basis in both the public and especially the private sphere, and the government's responses in the form of laws and programs have been insufficient to ensure adequate protection for women. Indeed, a recent study found that half of all murders of women in Chile were femicides, and many of these were the culmination of a long history of violence reported by the women themselves. (4)

Unlike the situation in other countries, in Chile the neoliberal model is founded upon a discourse of modernity limited solely to economic liberalism and excludes individual freedom in the cultural sphere, especially in the areas of sexuality, reproduction and the family, issues that are referred to as "moral concerns." Paradoxically, economic liberalization is coupled with the restriction of individual freedom in the private sphere, constituting a serious barrier to the recognition, protection and exercise of women's human rights, especially their sexual and reproductive rights. It also seriously calls into question the separation of Church and State that was enshrined in the Chile's 1925 constitution.

Today, despite the existence of democratically elected governments, sectors of the Chilean state have been subordinated to certain interest groups, such as the Catholic Church hierarchy and Opus Dei, which have exerted pressure on government authorities, most notably the Ministries of Health and Education. These pressures have hindered the design and implementation of legal frameworks and public policies for sexual and reproductive rights. This situation is reinforced by the conduct of political forces within the ruling coalition that continuously seek to generate consensus with the once-dominant conservative sectors. Such actions have suppressed public debate in Chilean society around the country's model of economic and cultural development. At the same time, the current of conservatism running through different political parties makes it difficult to reach common ground on issues related to sexuality, the family and private life; instead, issues are prioritized that are more likely to generate alliances.

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This means that legislation and public policies related to sexuality, notably health and education policies, do not meet the population's real needs that have emerged from underlying changes in Chileans' beliefs, attitudes and behavior. Chilean society has undergone transformations in the realms of sexuality, reproduction and gender roles. These include earlier sexual initiation and premarital sex; a concern for sexual pleasure; and more equitable initiation of sex between men and women. Other changes include a greater diversity in family structures, an increase in single-parent families and blended families, an increase in children born out of wedlock and higher rates and earlier occurrences of adolescent pregnancy.

Also notable in recent years are women's greater participation in the public sphere and greater visibility and acceptance of sexual diversity. These changes point to a gap between citizens' real beliefs and behavior and the traditional discourse on sexuality and the family that is expounded by conservative groups associated with Catholic Church hierarchy and presented in the media as the only reality in Chile.

Even though 70% of Chileans declare themselves to be Catholic (2002 Census), many of them do not agree with the "moral guardianship" of the Church on issues related to their private lives. Most Chileans do not share the ideology of the Catholic Church hierarchy but aspire to a greater degree of individual freedom and autonomy when making choices about their sexuality and reproduction, following their own personal beliefs more than official religious teachings.

Demographics

According to the 2002 Census, Chile has a population of 15,116,435 inhabitants. Population growth has slowed significantly with Chile now one of the four Latin American countries with the lowest rate of growth. (5)

Chile's inhabitants are primarily city dwellers with 86.6% of the population living in urban zones and 13.4% in rural areas. This represents an increase over 1992 when 83.5% of the country's inhabitants lived in cities. (6)

Women make up 50.7% of the Chilean population and men 49.3%, which means that for every 100 women in Chile there are 97.1 men (the masculinity index). (7) Nevertheless, the country's more remote areas and rural zones register masculinity indexes greater than 100 (more men than women), which can be explained by the migration of women, mainly young females, to the country's central and urban areas. (8)

In regard to age-group distribution, there has been a decrease in the under-15 population and an increase in those 60 years of age and older with the former accounting for 25.7% of the population and the latter 11.4%. (9)

Marriage is still prevalent among the over-15 population though less so than in 1992 (46.2% versus 51.8%, respectively). Another increase is found among the number of common-law couples (from 5.7% to 8.9%) and separated couples (3.4% to 4.7%). (10)

Seventy percent of the country's over-15 population profess Catholicism. However, this too represents a decrease over the 1992 Census (76.7%). By contrast, the percentage belonging to evangelical Protestant groups increased from 12.4% in 1992 to 15.1% in 2002, and those declaring themselves to be agnostic, atheist or to not subscribe to a religious belief also increased (from 5.8% to 8.3%) over the same period. (11)

The 2002 Census was the first such survey to ask Chileans about their ethnicity. The results indicate that 4.6% of the population (692,192 individuals) belonged to one of eight indigenous groups recognized in Chilean legislation. Of this group 87.3% identified as Mapuche, 7% Aymara, 3% Atacameno, 0.9% Quechua, 0.7% Rapanui, 0.5% Colla, 0.4% Alacalufe and 0.2% Yamana. (12)

Also worth noting is that the 2002 Census recorded 184,464 foreign residents in Chile, representing 1.2% of the population. (13) Among these, 52.2% are women. The degree of underreporting in this category is unknown, but fear of persecution may discourage undocumented immigrants from identifying themselves as foreigners.

According to the 2002 Census, Chile has a literacy rate of 95.8% among the population 10 years of age and older. Although the urban rate is higher than the rural rate, the latter also has increased significantly among women over 45 years of age, bridging the historical urban-rural gap. (14)

Dropping Fertility Rates and Differential Factors

Fertility rates among Chilean women have dropped notably in recent decades. From the 5.3 children per woman reported in 1960, the rate dropped by more than half to 2.5 in 1980, then further to 2.1 in 2000 and 1.9 in 2003. (15)

This decrease in fertility is related to far-reaching socio-cultural factors such as women's greater participation in the workforce, increased opportunities in women's lives and the desire for smaller families. The reduction also was enabled by broader access to contraception, including those available through public programs that date from the 1960s.

Nevertheless, fertility has not decreased to the same degree among all women; the rate varies by age, level of education, urban/rural status and other factors. For example, according to information reported by the Chilean office of vital statistics, between 1993 and 2003 the fertility rate dropped notably among women 20 to 24 years of age (from 122.6 to 94.0) and among those 25 to 29 years of age (from 124.3 to 100.6), by 28.6 and 23.7 points, respectively. Over the same period, fertility among women under 20 has decreased less dramatically (from 63.9 to 54.7). Fertility rates among women 30 to 34 dropped slightly (from 94.1 to 88.6), and a slight increase has been observed in fertility rates among women 35 to 39 years of age (from 51.2 to 51.7), as well as among those 40 to 44 years old (from 14.5 to 14.9). (16)

Based on women's own responses, the 2002 Census calculated that Chilean women have an average of 2.26 children each. (17) Fertility among women living in urban areas is lower than those living in rural zones, with the former having 2.17 children and the latter 2.9, on average. (18) In addition, women with more years of schooling usually have fewer children than women with less schooling, a trend that remains constant across all age groups. (19)

Maternal Mortality in Chile

Maternal mortality in Chile has dropped steadily in recent decades in both absolute and relative terms (see Table 1 in the statistical annex). In 1960, 845 women died from this cause, a rate of 299 per 100,000 live births, while in 1970, 439 deaths were reported, or 168 per 100,000. In 1980, this figure was 185 (73 per 100,000 live births), and in 1990, it stood at 123 (40 per 100,000 live births). Forty-nine deaths were reported in 2000 or 20 per 100,000 live births, and in 2003 (the most recent year for which figures are available), 33 women died from this cause or 14 per 100,000 live births. (20)

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Not all incidents of maternal mortality are reported, and the true figures are unknown. Nevertheless, in recent years great efforts have been made to increase reporting of maternal deaths through follow up on all deaths of women aged 15 to 45 to determine whether they were pregnant at the time of death. (21)

The downward trend in maternal deaths has been maintained in both absolute and relative terms in the past decade (1994-2003). In regard to the age distribution of women who died from this cause (see Tables 3.1, 3.2 and 3.3, p. 69), 61.1% corresponded to women 20 to 35 years of age, 30.6% to women over 35 and 8.3% to women under 20. The highest maternal mortality rates were found in the 35 to 39 age group (42.5 in 1994 and 27 in 2003) and among women 40 to 44 (133 in 1994 and 49.5 in 2003). (22)

Approaches to Maternal Mortality in Chile

The main reason for the drop in maternal mortality in Chile was implementation of public policies in reproductive health through the establishment of the National Health Service centers across the country in 1952. Since then, health care for women has focused on maternal and infant health, especially care during pregnancy, childbirth and the postpartum period, newborn and infant care and birth control. (23)

The concern for maternal mortality rates, particularly the death of women from abortion, led to the implementation of public services oriented towards "responsible parenthood" that were established in Chile beginning in 1964. Abortion always has been a major cause of maternal death.

The National Health Service Director during those years has said that abortion had reached epidemic proportions at the time and was responsible for half of all maternal deaths. These occurrences were an enormous financial burden on the public health system.

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Half of all blood available in the system was used to treat and hospitalize women suffering from the complications of septic abortions, reducing the number of beds available for poor women in labor. (24)

Diverse social and economic factors are responsible for the significant rise in abortion and hospitalization from this cause. Women urgently needed to regulate their fertility despite the risks associated with abortion. In 1960, over 57,000 hospitalizations for abortion were registered, and the rate of abortion was 31.1 per 1,000 women of reproductive age (15 to 49 years). Hospitalization for abortion decreased as birth control methods were developed beginning in 1967 when 10% of women of reproductive age had access to these services. (25)

Women's opportunity to control their fertility through greater access to contraceptive methods has been an important factor in decreasing maternal mortality as it diminishes the number of pregnancies and births and decreases the number of unwanted pregnancies.

From 1965 onward, there is a notable decrease in deaths from abortion as well as a drop in maternal mortality in general. Though the drop in abortion-related deaths was significant, reductions in other causes of death also have been identified for this period. These reductions illustrate the positive impact of women's use of contraceptives, which allowed them not only to avoid unwanted pregnancy but also to further space their pregnancies and thereby improve their overall health. There was also a growing level of prenatal care available in primary health care centers and a steady increase in medical care during childbirth, which in 1965 already stood at 74.3%. Advances in obstetric technology also contributed to the downward trend in preventable deaths. (26)

Another factor that played a role in reducing maternal mortality in Chile was the long history of professional midwifery, (27) which dates to the 18th century, and its decisive role in prenatal care, during labor and postpartum care. (28) In 1925, 70% of all births were attended by parteras empiricas (lay midwives), 20% by matronas (trained midwives) and 10% by doctors. By 1955, doctors and trained midwives each attended 15% of all births with the remaining 70% handled by untrained birth attendants. Today, 70% of all births in Chile are attended by trained midwives (all normal births in the public health-care system) and 30% by doctors (mainly in the private system). (29) Professional midwives are distributed evenly among Chile's 13 regions with nearly 3,500 of these health professionals working in the public health-care system to provide care to women in the most remote areas of the country. (30)

In 1994, the Minister of Health decided to transform the traditional Maternal and Perinatal Health Program into the Women's Health Program, incorporating a "comprehensive health," gender-sensitive approach that sought to broaden non-reproductive care offered to women to cover the entire life cycle. (31) The Women's Health Program proposed to continue and strengthen sexual and reproductive health care in the areas of sex education, care during the prenatal period and childbirth, family planning and STD prevention, including HIV/AIDS. The program expressed concern regarding the magnitude, persistence and consequences of induced abortion and the need to avoid it through family planning. (32) In addition, it places special emphasis on the adolescent population. (33) Non-reproductive aspects of the program include efforts in the areas of mental health, occupational health, menopause and health, and nutrition. (34)

A number of years have passed since this program was implemented, and the positive indicators that are used traditionally to rate reproductive health care have remained high; however, there is still a gap between the programmatic discourse and actual practice. Induced abortion continues to be a serious public health problem; adolescents' special need for information and access to services has not been properly resolved; and coverage is still lacking for birth control and access to the full range of contraceptives available. In addition, men have only been partially incorporated into the reproductive process, and the system reinforces women's responsibility for pregnancy prevention. At the same time, there is a serious lack of participation by women in the design, execution and evaluation of policies and programs. Other weaknesses include the lack of comprehensive health care for women throughout the entire life cycle, the lack of concern for domestic and sexual violence, as well as sexuality in general, in women's health care. (35)

In Chile, the beneficiaries of the public health-care system can access the fertility regulation and contraception services offered by this system free of charge. Today (2004), coverage of these services reaches 30% of women of reproductive age (1,079,388 women). The methods offered consist basically of intrauterine devices and contraceptive pills (combined oral), which together are used by 90% of women practicing birth control. Other contraceptive methods available in the public system include oral progestogen contraceptives (4%), contraceptive injections (0.7%) and condoms (3.6% women and 0.8% men). Surgical birth control methods were used by 13,449 women and 111 men in 2004. (36) The absence of methods such as diaphragms, female condoms, spermicides, hormone implants and emergency contraception illustrates that women and men still cannot freely choose from among the broad range of contraceptive methods currently available to the public elsewhere. (37) (Ed. note: The National Regulations on Fertility Regulation approved in 2007 promote more diverse and improved contraceptive methods, including emergency contraception, for users of the public health services. Nonetheless, these regulations have been challenged as unconstitutional while the government and key sectors of civil society continue to support them.)

Publicly available birth-control services also present a serious gender bias. Even though they say they are targeted towards "women and/or couples of reproductive age," in practice they target women only, reinforcing the notion that responsibility for preventing pregnancy lies with women, thus relieving men of any responsibility. Furthermore, these services are not promoted, and the programs only stipulate that they be targeted towards those individuals who come to public health clinics seeking care ("spontaneous demand"). This lack of dissemination and promotion is more serious in the case of the adolescent population, which is supposed to be a priority of the Women's Health Program. (38)

The percentage of women obtaining contraception is higher than that reported by the public health system as Chilean women also use private medical offices and buy directly from pharmacies. According to one study of quality of life conducted by the Ministry of Health in 2001, 61% of women between the ages of 15 and 44 used some contraceptive method to avoid unwanted pregnancy. However, adolescents are less protected: only 23% of women 15 to 19 years old use a method compared to 68% of women 20 to 44 years of age. (39)

Despite greater access to contraceptive methods, induced abortion continues to be one of the main causes of maternal morbidity and death in Chile.

One positive note is the excellent professional health coverage provided during childbirth in Chile. Since the early 1990s, such coverage has surpassed 99% and without a doubt has been directly associated with keeping maternal mortality rates low. It also is indicative of the broad geographical distribution of public health establishments. The level of development of Chile's public health services has enabled broad access to timely and regular medical care and to technologies that support such care by quickly resolving most pathologies that arise during pregnancy and childbirth.

Nevertheless, public health offices in all regions of the country are not able to provide the same level of timely and effective care either because of infrastructure deficiencies or lack of professional resources, especially for specialized care and provider training. A case in point is the recognized lack of professional anesthesiologists in the public health system. Furthermore, some public health establishments face harsh economic realities that reflect the economic uncertainty of the population residing in their catchment area. (40)

Despite this situation, some outreach initiatives have been implemented in recent years to forge ties between the public health department and the Mapuche and Aymara people in Regions IX and I, respectively. This has enabled the provision of health services (including obstetrics) that are respectful of native beliefs and traditions.

Chile has a notably high rate of cesarean sections in the public health-care system and an even higher one in the private system. (41) In 2000, 30% of births in the public system and 60% of those in the private system were cesareans (37% of all births), reflecting a rise over previous years. By 2004, cesareans still accounted for 31.6% of all births in the public health system. (42)

Despite the low maternal mortality rate Chile has recorded, the issue continues to be an important public health concern. Further reductions have been achieved through the continuity of the reproductive health policies indicated above. A 50% decrease in maternal mortality rates is one of Chile's public health goals for the 2000-2010 period; in other words, by 2010 this rate should have dropped to 12 deaths per 100,000 live births. (43)

The plan is to reduce maternal death by: 1) reducing the number of unwanted pregnancies and high-risk pregnancies; 2) reducing the number of obstetric complications; and 3) reducing the mortality rate among women presenting complications. This means developing strategies and interventions oriented towards "increasing the availability of and access to information and family planning services in order to substantially reduce the number of pregnancies, especially high-risk and unwanted pregnancies," and "ensuring that all women have access to high-quality health-care services during pregnancy, childbirth and the postpartum period in order to reduce the number and seriousness of obstetric complications ... to provide information on the prevention and treatment of illness during pregnancy and on early detection and treatment when complications arise," and "to provide essential obstetric care to all women who require it with the aim of reducing the death rate when complications arise." (44)

These proposals are important for targeting the main causes of maternal death. However, they also suffer from a serious shortcoming as they do not precisely define the departments that will be responsible for carrying out the changes that the strategies require. Neither do they establish follow-up mechanisms to enable their full achievement within the time period specified. Of particular concern is the approach to unwanted pregnancy, which the Ministry of Health itself recognizes as a public health concern and a threat to the personal health of the women affected because of the high number of abortions performed for this reason in Chile. (45) The Ministry states that resolving the unsatisfied demand for birth control and thereby decreasing the demand for abortions will require "strengthening birth-control activities while guaranteeing quality of care, a strategy that involves: information-education-communication; promotion of sexual and reproductive rights; training of health-care personnel in sexual and reproductive health; strengthening educational and counseling activities that enable clients of these services to make fully informed decisions regarding sexuality and reproduction; increasing the current level of coverage; expanding the variety of contraceptive methods available; and focusing actions towards more vulnerable groups (youth, the poor, female heads of household)." (46)

To date, however, the actions identified as priorities have not been fully implemented. The public health service does not disseminate information on sexual and reproductive rights; health-care personnel have not been trained in sexual and reproductive health; (47) coverage has expanded only slowly; and contraceptive alternatives are still limited and are highly concentrated in two methods (IUD and combined oral contraceptives). As mentioned above, this situation is aggravated by the gender bias in the public health services as well as the lack of dissemination and promotion of the services available.

Analysis of the Main Causes of Maternal Mortality in Chile

In the period studied (1994-2003), the principal causes of maternal death observed included hypertension, direct obstetric causes and abortion (see Table 2.1, 2.2 and 2.3, p. 68). Over the ten-year period, 130 women died from gestational hypertension, 120 from direct obstetric causes and 113 from abortion. In all, these three causes accounted for 64% of all maternal deaths. Indirect obstetric causes caused the death of 106 women (18.7%), followed by hemorrhage (42 deaths) and postpartum complications (40 deaths). The least frequent causes were infection (15 deaths) and obstructed labor (one death).

Arterial hypertension (AHT) is the most frequent health complication and cause of death among pregnant women (eclampsia during pregnancy, postpartum eclampsia, gestational hypertension, severe preclampsia). Women suffering from this pathology require specific, highly specialized treatment. Successful treatment depends on timely diagnosis and referral to specialized obstetrical services as well as on the proper education of women and their families and communities.

One of the greatest difficulties in analyzing the causes of maternal mortality in Chile adequately is the absence of public records documenting the examination of maternal deaths that occur in each public health facility. The lack of data obscures socio-demographic factors that place some segments of the population at a much higher risk of maternal mortality than others.

Under current practice, a multi-level committee is formed in the clinic or hospital for each case of maternal death that occurs. The committee conducts an investigation to identify the factors that contributed to the death and assesses the timeliness and quality of care the woman received at each level. As there is no standard investigative protocol, the nature of the investigation is determined on an ad hoc basis. Once the process is concluded, the recommendations adopted are implemented at each level of care to prevent similar problems in the future. However, no systematic public records of the investigations conducted by these committees exist, which makes it impossible to analyze the biological, institutional and/or social factors that play a role in these deaths.

Neither does the Ministry of Health record a socio-demographic profile of women who die from causes related to pregnancy and childbirth, which would allow for the definition and prioritization of suitable preventive public health actions and the assessment of their impact over time.

Notwithstanding these large gaps in the available information, we can observe that maternal deaths occur more frequently in poor areas. A detailed review of the records of maternal deaths in 2001, 2002 and 2003 reveals that the most vulnerable regions are precisely those with the largest number of rural inhabitants. (48) In the south-central zone, this includes the Maule Public Health Service in Region VII (Longavi Municipality) and the Libertador B. O'Higgins Public Health Service in Region VI (Municipalities of Requinoa and Donihue). In the south, it covers the Region IX Araucania Norte Public Health Service (Renaico Municipality), while in north-central Chile, it includes the Coquimbo Public Health Service (Region IV, Monte Patria Municipality) and the Vina del Mar-Quillota Public Health Service (Region V, La Ligua Municipality).

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Abortion in Chile

During both the period studied (19942003) and in previous decades, abortion was one of the main causes of maternal death in Chile. Though deaths from abortion have tended to decrease over the years, the fact that this phenomenon persists points to a serious infringement of the basic human rights of Chilean women.

Deaths from abortion are preventable deaths and should not occur in a country such as Chile with such a highly developed public health system. However, the legal ban that applies to any interruption of pregnancy forces women to turn to clandestine, unsafe abortion. Chile is one of the few countries in the world that criminalizes abortion in all cases without exception. (49) Even therapeutic abortion is banned, although it had been legal from 1931 to 1989. (50) The serious threat to human rights that such criminalization imposes on women has led more than one United Nations commission to recommend that the Government of Chile review this legislation. (51)

All health personnel by law must report women who have had abortions to the authorities, and clear regulations to allow them to fulfill their professional mandate of confidentiality are absent. These legal provisions make health professionals play accuser and judge. Many women delay seeking timely health care for complications arising from clandestine abortion for fear of being arrested by the police in the clinic. Even though Chilean legislation defines abortion as a crime, health staff should limit themselves to treating to its consequences and safeguarding women's health and lives with full respect for their confidentiality. Such actions are necessary if women's human rights are to be upheld, as has been communicated by various UN commissions to the Government of Chile on a number of occasions.

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Due to the criminalization of abortion and its consequent illegal and clandestine occurrence, there are no official figures on the number abortions in Chile. Estimates from the 1990s suggest that somewhere on the order of 160,000 induced abortions occur per year (i.e., one out of every three pregnancies). (52)

The only information available is based on hospital releases of women who were admitted with complications due to abortion. These figures include both induced and spontaneous abortions (miscarriages) in which complications occurred that drive the women to seek medical attention in public or private health clinics. The number of induced versus spontaneous abortions occurring each year is not known. These figures reflect a decrease in hospitalizations for abortion from 36,885 in 1990 to 30,146 in 2000. (53) This decrease may be a result of the lower numbers of abortions practiced or it may reflect an improvement in techniques and procedures used to perform the procedure (e.g., better and increased use of antibiotics, use of misoprostol). (54)

Although the vast majority of abortion cases do not come before the courts, women are still prosecuted and imprisoned for having had an abortion in Chile, and the threat is experienced disproportionately by the poorest women.

One of the most serious aspects of the current situation in Chile is the lack of humanized care given to women who have abortions. (55) Though women suffering complications from abortion are given medical attention, (56) there is no specific policy or program for humanized care after an unsafe abortion. Health-care staff have not been sensitized or trained to provide quality of care to women who suffer complications from abortion. Health establishments do not perform vacuum aspiration (MVA), nor do they guarantee that women will have anesthesia administered. Nor are there institutional efforts aimed at preventing the poor treatment that women often receive at the hands of medical and non-medical staff. (57, 58)

Challenging the total criminalization of abortion is extremely complicated. Indeed, not one of the three democratically elected administrations in Chile since 1990 has placed the issue of abortion on the public agenda, not even to reestablish therapeutic abortion, which was repealed in the final months of the military dictatorship. During its 15 years of operation since the dictatorship (from 1990 to 2005), the National Congress has received only two bills to reinstate therapeutic abortion, which were presented in 1991 and 2003. Neither of these were even debated due to a complete lack of support from the executive branch. On the other hand, conservative parliamentarians have presented four bills to increase the penalties imposed on women for having an abortion. Only one of these came to the floor for debate and was voted down by the Senate in 1998 by a narrow margin. (Ed. note: Another more recent proposal for the decriminalization of abortion was rejected without review.)

Recent administrations' silence on this serious human rights problem illustrates the inability of the current democratic system to resolve the most important issues of gender inequity. This situation only expands the gap between the ruling political class and the general public and its concerns and even the way in which citizens take a stand in regard to problems left un-addressed by traditional politics. In fact, a number of opinion polls have found broad public support for the need to modify existing legislation on abortion. (59) Recently, the National Opinion Poll on the Political Perception and Electoral Implications of Registered Women Voters conducted by the Corporacion Humanas and the Universidad de Chile showed a high level of support for abortion under certain circumstances: 67% of the women surveyed agreed with the use of abortion to protect the woman's health; 58% agreed in the case of severe fetal malformation; and 55% in the case of pregnancy resulting from rape. The level of support for abortion in cases of economic hardship was only 15%. Notably, 56% of women thought that in all cases the decision to abort should rest with the woman herself. (60)

Recommendations by Human Rights Watchdog Groups on Maternal Mortality and Abortion in Chile

The complete criminalization of abortion under laws obligating health-care staff to report women who seek medical attention for complications derived from abortion, coupled with the abuse these women receive at the hands of health-care staff, constitute a serious infringement of Chilean women's human rights. Such violations have been observed on an ongoing basis by different United Nations Commissions charged with monitoring compliance with international human rights treaties.

Beginning in 1999, the main Commissions monitoring governments' respect for human rights communicated to the Government of Chile on numerous occasions that the criminalization of abortion was a violation of women's rights. In 1999, statements to this effect were issued by the United Nations Human Rights Commission (61) and the Committee on the Elimination of Discrimination against Women (CEDAW). (62) In 2004, the Committee Against Torture (CAT) (63) and the Committee on Economic, Social and Cultural Rights (64) both expressed similar concerns.

These committees have recommended that current Chilean legislation be changed to allow abortion under certain circumstances such as to protect the life and health of the woman, including her mental health, or in the case of pregnancy resulting from rape and incest. They also called upon the State to provide safe abortion to women, strengthen measures for preventing unwanted pregnancy and widen access to contraceptives. In addition, Chile has been advised to conduct a review of legal requirements that health-care staff report women who seek medical attention from complications arising from abortion; to guarantee these patients confidentiality as well as immediate, unconditional emergency care; and to abolish the practice of eliciting confessions that can be used against them in criminal charges.

Though it has been several years since these bodies recommended the review of the aforementioned punitive legislation, this advice has been completely ignored by Chilean authorities. The recommendations formulated by the United Nations commissions have not been sufficiently publicized within the government or among the citizenry. Likewise, not a single step has been taken to open a discussion on abortion that could enable the suggested legal changes to be made; neither have legal provisions been adopted to enable health-care staff to fulfill their obligation to respect the confidentiality of their patients. Nor have measures been adopted to eliminate the mistreatment--which is in effect torture--that women experience in some hospitals.

Recommendations and Proposals for Action

* Train experts and spokespeople from the women's health movement and civil society to advocate and participate in defining and implementing a legislative framework and public policies that guarantee sexual and reproductive rights, with emphasis on reducing maternal mortality.

* Promote public debate on maternal mortality, its prevention, preventability and serious consequences that recognizes these deaths as violations of women's human rights.

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* Improve systems for registering maternal deaths to reduce underreporting. Instruct health-care staff in the proper registration of such deaths. Form and train teams of experts to follow up on maternal deaths.

* Form maternal mortality committees to analyze the causes of maternal deaths and their preventability. Establish protocols for the operation of these committees and the instruments for collecting information on risk factors and other relevant variables. Factors should include: individual factors (age, number of births, history of abortions, use of contraception, nutrition, etc.); socio-economic factors (years of schooling, marital status, place of residence [urban vs. rural], ethnicity or race, employment situation, income level, access to information, access to transportation, etc.); health factors (stage during which the death occurred [pregnancy, labor or postpartum]); place of death (hospital, public or private health clinic, private residence, etc.); quality of care received; surgical interventions; transfusions; prenatal care; risk screening and early intervention.

* Establish a national body to systematize and analyze the information produced by the maternal mortality committees. Systematize and disseminate research results. Define and implement the recommendations formulated by the committees and assess their application.

* Include representatives from the women's health movement on the maternal mortality committees in addition to the respective health-care personnel.

* Incorporate a gender perspective in the definition, execution and evaluation of health policies, especially those for sexual and reproductive health, and ensure that these policies and programs are defined, executed and evaluated with the participation of women's organizations.

* Ensure comprehensive health care for women throughout their life cycle with special emphasis on traditionally weak aspects: sexual and reproductive health of adolescents and older women, sexuality, gender violence.

* Adopt comprehensive legislation that recognizes and protects the individual's right to free and autonomous choice in regard to their sexuality and reproduction, and make available information and services required to accomplish this goal. Implement mechanisms that protect women from the violation of their sexual and reproductive human rights. Ratify the Optional Protocol of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and implement a Human Rights Ombudsman's Office.

* Provide ongoing training to healthcare staff on quality of care and sexual and reproductive health from a gender perspective.

* Ensure that the community has information on sexual and reproductive health, especially birth control.

* Increase coverage of birth-control services and expand the variety of contraceptive methods available to women and men, including emergency contraception. Broadly publicize the existence of these services, and promote their use among adolescents, women and men.

* Humanize care for treatment for complications arising during pregnancy, childbirth and postpartum. Promote and facilitate the accompaniment of women during prenatal visits, childbirth and the postpartum period.

* Promote public debate on abortion and the serious consequences of clandestine, unsafe abortion for women's health and lives.

* Implement the recommendations formulated by the UN Human Rights Commission, the CEDAW Committee, the Committee on Torture and the Committee on Economic, Social and Cultural Rights to review punitive legislation on abortion and establish exceptions to its total ban.

* Humanize care for complications arising from clandestine abortion. This involves at a minimum ensuring that women who come to hospitals for treatment of such complications receive quality care, understanding and multidisciplinary medical advice that enables them to them to redefine their experience and adopt measures to prevent the need for abortion in the future, such as suitable information and counseling on contraceptive methods and birth control.

* Train health care staff to provide humanized, high-quality care for complications arising from abortion.

* Decriminalize the voluntary interruption of pregnancy and guarantee access to high-quality medical attention for these cases.

* Incorporate the participation of women's organizations in the definition, implementation and evaluation of policies, programs and/or services for complications arising from unsafe abortion.

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Notes

(1.) This section draws heavily on the chapter "Contexto socioeconomico y cultural chileno" from Derechos Sexuales y Reproductivos en Chile a diez anos de El Cairo. Monitoreo del Programa de Accion de la Conferencia Internacional sobre Poblacion y Desarrollo, CIPD'94. (Santiago, Chile: Foro-Red de Salud y Derechos Sexuales y Reproductivos-Chile, Red de Salud de las Mujeres Latinoamericanas y del Caribe) 18-21.

(2.) In 1990, 32.4% of the female population was gainfully employed in the formal market. This percentage increased to 42% in 2003. Ministerio de Planificacion y Cooperacion, Encuesta Caracterizacion Socioeconomica, Documento Mujer Casen 2003, 42.

(3.) Chile is one of the few countries in the region that has not adopted a quota law or some other mechanism of affirmative action in this regard, despite recommendations by several international entities including the Human Rights Committee and the CEDAW Committee in 1999.

(4.) United Nations, Corporacion La Morada, Femicidio en Chile (Santiago, Chile: United Nations, Corporacion La Morada, 2004).

(5.) Instituto Nacional de Estadisticas, Censo 2002 Sintesis de Resultados (Santiago, Chile: INE, March 2003) 9.

(6.) Ibid. 11.

(7.) At the time of the 2002 Census, there were 7,668,740 women and 7,447,695 men living in Chile. Ibid. 10.

(8.) The Metropolitan Region of Santiago has a masculinity index below the national average with 94.7 men per 100 women. Ibid. 11.

(9.) Ibid. 12.

(10.) In 2002, unmarried individuals, widows/ widowers and people who had their marriages annulled comprised 34.6%, 5.2% and 0.4% of the population respectively, which has not changed significantly since 1992. Ibid. 14.

(11.) Ibid. 25.

(12.) Ibid. 23.

(13.) Ibid. 18.

(14.) Ibid. 20.

(15.) Instituto Nacional de Estadisticas, Anuarios de Demografia y Estadisticas Vitales.

(16.) Instituto Nacional de Estadisticas, Anuario de Estadisticas Vitales 2003 (Santiago, Chile: INE, 2005) 73.

(17.) The Anuarios de Estadisticas Vitales are based on the national records of life events, and the birth rate is calculated based on the registrations of births and the female population. On the other hand, the census reflects the results of the nationwide household survey where the information about births is calculated from data taken from women over age 15. This different manner of data collection could explain the minimal difference between the birth rates seen in these two sources.

(18.) Instituto Nacional de Estadisticas, "Resultados Generales Censo 2002" (Santiago, Chile: INE, 2002) Table 3.1.

(19.) Women aged 20 to 24 have an average of 0.6 children, but the fertility rate of women with less than ten years of schooling is 1.1 children compared to 0.2 children among women with 13 or more years of schooling. Women aged 25 to 34 have an average of 1.5 children, but those with under seven years of schooling have an average of 2.2 children compared to women with 13 to 16 years of schooling (1.1 children) and only 0.7 children among those with 17 or more years of schooling. Women aged 35 to 44 have an average 2.4 children, but those with under seven years of schooling have an average of 2.9 children. Those with 13 to 16 years of schooling have 2.0 children, and those with 17 or more years of schooling have 1.9 children. Servicio Nacional de la Mujer, Instituto Nacional de Estadisticas, Mujeres Chilenas. Tendencias de la ultima decada (Censos 1992-2002) (Santiago, Chile: SERNAM, INE, 2004) 72-75.

(20.) Ministerio de Salud, Mortalidad Materna en Chile (Santiago, Chile: Ministerio de Salud, 2002). Information for 2003 from Instituto Nacional de Estadisticas, Anuario de Estadisticas Vitales 2000 (Departamento de Estadisticas Vitales, Ministerio de Salud).

(21.) Interview with the head of the Departamento de Informacion y Estadisticas, Ministry of Health.

(22.) Instituto Nacional de Estadisticas, Anuarios de Estadisticas Vitales (information from 1994 to 2000). Information 2001, 2002 and 2003 from the Departamento de Estadisticas e Informacion, Ministry of Health.

(23.) In addition to the drop in maternal mortality, these public policies and programs resulted in a decrease in infant mortality and other improvements in public health.

(24.) Interview with Francisco Mardones, Director of the public health system, the Servicio Nacional de Salud, during the 1960s, in Ximena Jiles, De la miel a los implantes. Historia de las politicas de regulacion de la fecundidad en Chile (Santiago, Chile: Corporacion de Salud y Politicas Sociales, 1992) 125.

(25.) Tegualda Monreal, "Evolucion historica del aborto provocado en Chile y la influencia de la anticoncepcion." In Memoria Simposio Nacional Leyes para la Salud y la Vida de las Mujeres Hablemos de Aborto Terapeutico (Santiago, Chile: Foro Abierto de Salud y Derechos Reproductivos, 1993) 15-26.

(26.) Ministerio de Salud, Objetivos Sanitarios para la Decada 2000-2010 (Santiago, Chile: Ministerio de Salud, 2002) 10.

(27.) In Chile, nurse-midwives are referred to as matronas. In other countries of the region, they are called obstetrices, parteras or enfermeras obstetricas.

(28.) B. Baeza, paper presented in the Simposio "Colaboradores para la Salud Publica en las Americas" held in Washington, D.C., by PAHO/WHO in 2002.

(29.) Francisco Mardones Restat, "Del empirismo al profesionalismo en la atencion del nacimiento" (Santiago, 2000).

(30.) Ana Ayala, nurse-midwife responsible for the Women's Heath Program of the Ministry of Health, working paper 2004.

(31.) Ministerio de Salud, Programa Salud de la Mujer (Santiago, Chile: Ministerio de Salud, 1997) 7.

(32.) Ibid., 11, 12 and 22.

(33.) "Early initiation of sexual activity by young people without adequate information and individual responsibility exposes them to situations that can seriously compromise their health and life plans such as unwanted pregnancy, abortion, STIs. For this reason, the adolescent population should be a central focus of concern in the areas of sexual and reproductive health." Ibid. 12.

(34.) Ibid., 7, 13-15.

(35.) Camila Maturana, Derechos sexuales y reproductivos en Chile a diez anos de El Cairo. Monitoreo del Programa de Accion de la Conferencia Internacional sobre Poblacion y Desarrollo, CIPD'94 (Santiago, Chile: Foro-Red de Salud y Derechos Sexuales y Reproductivos-Chile, Red de Salud de las Mujeres Latinoamericanas y del Caribe, 2004) 83.

(36.) Departamento de Estadisticas e Informacion, Ministry of Health.

(37.) Emergency contraception is not among the contraceptive methods offered in public health facilities but is included in the emergency treatment provided for women who have been raped. Ministry of Health, Normas y Guia Clinica para la Atencion en Servicios de Urgencia a Personas Victimas de Violencia Sexual (Santiago, Chile: Ministry of Health, 2002).

(38.) Maturana (2004) 84.

(39.) Ministry of Health, Instituto Nacional de Estadisticas, Primera Encuesta Nacional de Calidad de Vida y Salud (Santiago, Chile: INE, 2001). Even though this survey provides information on the use of contraceptive methods in Chile, it is not really a survey of fertility nor does it include aspects that would demonstrate the need of the population in terms of information, services and access to contraceptive methods nor to what extent these needs are met in a timely fashion.

(40.) Primary care, the first level of medical treatment, is decentralized and managed by the municipalities which receive funds from the Ministry of Health, allocated according to the number of residents signed up with each health center. Internal document of the Unidad de Atencion Primaria, Departamento DIGERA, Subsecretaria de Gestion y Redes 2005.

(41.) Public health officials are aware of this problem and recognize that Chile "exhibits the highest rate of cesareans in the world (40%)." Ministry of Health, Los Objetivos Sanitarios para la Decada 2000-2010 (Santiago, Chile: Ministry of Health 2002) 14.

(42.) Departamento de Estadisticas e Informacion, Ministry of Health.

(43.) Ministry of Health, Los Objetivos Sanitarios para la Decada 2000-2010 (Santiago, Chile: Ministry of Health, 2002) 9.

(44.) Ibid., 10.

(45.) Ibid., 11.

(46.) Ibid.

(47.) The Ministry of Health has carried out some training activities in sexual and reproductive health in collaboration with other organizations, but these initiatives have been limited in scope.

(48.) Departamento de Estadisticas e Informacion, Ministry of Health.

(49.) The law consigns women who have an abortion to between three years and one day and five years or in the case of a woman who has an abortion to hide her "dishonor" to between 541 days and 3 years. This same sentence is recommended for those who perform abortions with higher sentences in the case of health professionals (Penal Code, art. 342-345). Placing abortion in the Penal Code chapter "Crimes and misdemeanors against the family, public morals and sexual integrity" and the attenuating factor of "honor" reflects the fact that the criminalization of abortion is meant to ensure the fulfillment of moral norms and social restrictions on women's sexual behavior.

(50.) Therapeutic abortion was eliminated during the last few days of the military regime. Since 1931, article 119 of the Health Code stated that "pregnancy may only be interrupted for therapeutic purposes. To proceed with this intervention, the documented opinion of two surgeons are required." This was changed with Law No. 18.826, issued by the military junta September 15, 1989, which stated that "no action may be undertaken with the intent to provoke an abortion." This is one of the so-called "straitjacket laws" passed at the very end of the military dictatorship. Through a wide variety of legal norms, the military dictatorship established and regulated with minute detail countless aspects of national life in the political and economic realms.

(51.) The recommendations formulated by the Human Rights Committee (1999), the Committee on the Elimination of Discrimination against Women (1999), the Committee against Torture (2004) and the Committee on Economic, Social and Cultural Rights (2004) are analyzed in another section.

(52.) The best-known study was carried out by the Alan Guttmacher Institute. AGI estimated that 159,650 abortions were performed each year. The Alan Guttmacher Institute, Aborto clandestino: Una realidad latinoamericana (New York: AGI, 1994) 24. Another relevant study was carried out by Dr. Mariano Requena, who reported 175,897 abortions. Mariano Requena, "El aborto inducido. Problema de salud publica vulnerable," in Memoria Simposio Nacional Leyes para la Salud y la Vida de las Mujeres Hablemos de aborto terapeutico (Santiago, Chile: Foro Abierto de Salud y Derechos Reproductivos, 1993) 32.

(53.) No consolidated information is available for previous years regarding this sort of care in private institutions. In 2002, 23,548 hospitalizations for abortion were reported, 22,280 in 2003 and 21,857 in 2004, which is the equivalent of 13 hospitalizations for abortion to every 100 deliveries. Source: Departamento de Estadisticas e Informacion, Ministry of Health.

(54.) Camila Maturana (2004) 95.

(55.) Humane care for women who have abortions is one of the commitments assumed by the States that signed the Programme of Action at the International Conference on Population and Development: "Governments should take appropriate steps to help women avoid abortion, which in no case should be promoted as a method of family planning, and in all cases provide for the humane treatment and counselling of women who have had recourse to abortion." Report of the International Conference on Population and Development (Cairo, 1994) Para. 7.24.

(56.) Obstetric care that, as we have stated, has had a significant impact on reducing maternal mortality.

(57.) See Center for Reproductive Law and Policy, Foro Abierto de Salud y Derechos Reproductivos, Encarceladas: Leyes contra el aborto en Chile. Un analisis desde los Derechos Humanos (Santiago, Chile: Center for Reproductive Law and Policy, Foro Abierto de Salud y Derechos Reproductivos, 1998).

(58.) Camila Maturana (2004) 102.

(59.) The Encuesta Nacional Opinion y Actitudes de las Mujeres Chilenas sobre la Condicion de Genero (Santiago, Chile: Grupo Iniciativa Mujeres, 1999) demonstrated significant levels of acceptance of abortion. Eight out of ten women approve of abortion when the woman's life is in danger, seven out of ten when the fetus has a serious malformation, and six out of ten in the case of pregnancy resulting from rape or incest. Another national opinion poll carried out in 2001 by the Facultad Latinoamericana de Ciencias Sociales revealed that most Chileans (both women and men) think that the country should legislate on abortion (57.6%). Those surveyed were of the opinion that abortion should be allowed in the event of danger to the woman's life (65.6%), pregnancy as the result of rape (58.3%) and in the case of serious fetal malformations (56.3%). In addition, 21.3% think that abortion should be permitted whenever a woman requests.

(60.) Corporacion Humanas; Instituto de Asuntos Publicos, Departamento de Ciencia Politica, Universidad de Chile, Encuesta Nacional de Opinion: Percepcion Politica e Implicancias Electorales de las Mujeres Inscritas en los Registros Electorales Chile, Resumen Ejecutivo (Santiago, Chile: Corporacion Humanas, Universidad de Chile, 2005) 15. This nationwide survey was applied between May and June of 2005 to 1,222 women over the age of 18 who were registered to vote in the national elections.

(61.) With regard to Chile's compliance with the Covenant of Civil and Political Rights, the Human Rights Committee has stated: "The criminalization of all abortions without exception raises serious issues, especially in the light of unrefuted reports that many women undergo illegal abortions that pose a threat to their lives. The legal duty imposed upon health personnel to report on cases of women who have undergone abortions may inhibit women from seeking medical treatment, thereby endangering their lives. The State party is under an obligation to take measures to ensure the right to life of all persons, including pregnant women whose pregnancies are terminated. In this regard: The Committee recommends that the law be amended so as to introduce exceptions to the general prohibition of all abortions and to protect the confidentiality of medical information." Concluding observations of the Human Rights Committee: Chile. 30/03/99. CCPR/C/79/Add.104. Para. 15.

(62.) The Committee on the Elimination of Discrimination against Women has indicated that "... The Committee is concerned at the inadequate recognition and protection of the reproductive rights of women in Chile. The Committee is especially concerned at the laws prohibiting and punishing any form of abortion. This law affects women's health, increases maternal mortality, and causes further suffering when women are imprisoned for violation of the law...." (Para. 228). "The Committee recommends that the Government consider review of the laws relating to abortion with a view to their amendment, in particular to provide safe abortion and to permit termination of pregnancy for therapeutic reasons or because of the health, including the mental health, of the woman. The Committee also urges the Government to revise laws which require health professionals to report women who undergo abortions to law enforcement agencies and which impose criminal penalties on these women. It also requests the Government to strengthen its actions and efforts aimed at the prevention of unwanted pregnancies, including by making all kinds of contraceptives more widely available and without any restriction...." (Para. 229). Committee on the Elimination of Discrimination Against Women, Concluding Observations: Chile (1999).

(63.) The Committee against Torture indicated its concern: "Reports that life-saving medical care for women suffering complications after illegal abortions is administered only on condition that they provide information on those performing such abortions. Such confessions are reportedly used subsequently in legal proceedings against the women and against third parties, in contravention of the provisions of the Convention" (D. Subjects of concern, Para. 6, letter j). It issued the following recommendation to the Chilean State: "Eliminate the practice of extracting confessions for prosecution purposes from women seeking emergency medical care as a result of illegal abortion; investigate and review convictions where statements obtained by coercion in such cases have been admitted into evidence, and take remedial measures including nullifying convictions which are not in conformity with the Convention. In accordance with World Health Organization guidelines, the State party should ensure immediate and unconditional treatment of persons seeking emergency medical care" (E. Recommendations, Para. 7, letter m). Conclusions and recommendations of the Committee against Torture: Chile. 14/06/2004. CAT/C/CR/32/5.

(64.) The Committee on Economic, Social and Cultural Rights has told the Chilean State: "The Committee is concerned about the consequences for women's health of the legal prohibition on abortion, without exceptions, in the State party. While there are no official statistics on the number of abortions performed annually, the large number of women who are hospitalized for abortion complications every year (34,479 in 2001) gives an indication of the extent of this problem" (Para. 26). And thus, "the Committee recommends that the State party revise its legislation and decriminalize abortion in cases of therapeutic abortions and when the pregnancy is the result of rape or incest" (Para. 53). Concluding Observations of the Committee on Economic, Social and Cultural Rights: Chile. 26/11/2004. E/C.12/1/Add.105.

Camila Maturana Kesten is a Chilean attorney specializing in women's rights. Fanny Berlagoscky Mora is a Chilean nurse-midwife. Both are longstanding women's health activists and scholars. The following article was submitted to the Latin American and Caribbean Women's Health Network under the project, "Strengthening the Capacity of the Latin American and Caribbean Women's Health Movement to Influence Public Policy."
Tables
Table 1. Maternal Deaths and Deaths Due to Abortion in Chile,
1960-2003 (number, rate and percentage)

Year Maternal Deaths Deaths Due to Abortion

 Number Rate * Number Rate * Percentage

1960 845 299 302 107 35.70%
1965 860 279 306 99 35.60%
1970 439 168 185 71 42.10%
1975 336 131 122 48 36.30%
1980 185 73 71 28 38.40%
1985 132 50 34 13 25.80%
1990 123 40 23 7 18.70%
1994 73 26.7 19 6.9 26.00%
1995 86 32.3 20 7.5 23.30%
1996 63 23.8 14 5.3 22.20%
1997 61 23.5 12 4.6 19.70%
1998 55 21.4 14 5.4 25.50%
1999 60 23.9 5 2 8.30%
2000 49 19.7 13 5.2 26.50%
2001 45 18.2 4 1.6 8.90%
2002 43 17.9 7 2.9 16.30%
2003 33 14.7 5 2.1 15.20%

* per 100,000 live births

Source: Anuarios de Demografia y Estadisticas Vitales (Instituto
Nacional de Estadisticas, Ministry of Health, Civil Registrar).
Figures for 2001, 2002 and 2003 from the Departamento de
Estadisticas e Informacion, Ministry of Health.

Table 2.1 Maternal Deaths According to Cause. Chile 1994-2003 (number)

Cause 1994 1995 1996 1997 1998

Hypertension 15 15 15 18 12
Direct obstetric causes 20 27 14 13 10
Abortion 19 20 14 12 14
Indirect obstetric causes 10 14 12 9 7
Postpartum complications 3 3 4 5 4
Infections 1 3
Hemorrhage 6 5 4 3 5
Obstructed labor 2
Total 73 86 63 61 55

Cause 1999 2000 2001 2002 2003

Hypertension 14 12 13 12 4
Direct obstetric causes 7 11 8 6 4
Abortion 5 13 4 7 5
Indirect obstetric causes 17 8 10 9 10
Postpartum complications 6 2 6 4 3
Infections 1 3 1 6
Hemorrhage 10 3 1 4 1
Obstructed labor
Total 60 49 45 43 33

Source: Anuarios de Demografia y Estadisticas Vitales (Instituto
Nacional de Estadisticas, Ministry of Health, Civil Registrar).
Figures for 2001, 2002 and 2003 from the Departamento de
Estadisticas e Informacion, Ministry of Health.

Table 2.2. Maternal Deaths According to Cause. Chile 1994-2003 (rate,
per 100,000 live births)

Cause 1994 1995 1996 1997 1998

Hypertension 5.48 5.64 5.66 6.92 4.67
Direct obstetric causes 7.31 10.15 5.29 5.00 3.89
Abortion 6.94 7.52 5.29 4.62 5.45
Indirect obstetric causes 3.65 5.26 4.53 3.46 2.72
Postpartum complications 1.10 1.13 1.51 1.92 1.56
Infections 0.38 1.17
Hemorrhage 2.19 1.88 1.51 1.15 1.94
Obstructed labor 0.75
Total 26.67 32.34 23.79 23.47 21.39

Cause 1999 2000 2001 2002 2003

Hypertension 5.58 4.82 5.28 5.02 1.71
Direct obstetric causes 2.79 4.42 3.25 2.51 1.71
Abortion 1.99 5.22 1.63 2.93 2.13
Indirect obstetric causes 6.78 3.21 4.06 3.77 4.26
Postpartum complications 2.39 0.80 2.44 1.67 1.28
Infections 0.40 1.22 0.42 2.56
Hemorrhage 3.99 1.21 0.41 1.67 0.43
Obstructed labor
Total 23.94 19.69 18.28 17.99 14.07

Source: Anuarios de Demografia y Estadisticas Vitales (Instituto
Nacional de Estadisticas, Ministry of Health, Civil Registrar).
Figures for 2001, 2002 and 2003 from the Departamento de
Estadisticas e Informacion, Ministry of Health.

Table 2.3 Maternal Deaths According to Cause. Chile 1994-2003
(distribution by percentage)

Cause 1994 1995 1996 1997 1998

Hypertension 20.5% 17.4% 23.8% 29.5% 21.8%
Direct obstetric causes 27.4% 31.4% 22.2% 21.3% 18.2%
Abortion 26.0% 23.3% 22.2% 19.7% 25.5%
Indirect obstetric causes 13.7% 16.3% 19.0% 14.8% 12.7%
Postpartum complications 4.1% 3.5% 6.3% 8.2% 7.3%
Infections 1.6% 5.5%
Hemorrhage 8.2% 5.8% 6.3% 4.9% 9.1%
Obstructed labor 2.3%
Total 73 86 63 61 55

Cause 1999 2000 2001 2002 2003

Hypertension 23.3% 24.5% 28.9% 27.9% 12.1%
Direct obstetric causes 11.7% 22.4% 17.8% 14.0% 12.1%
Abortion 8.3% 26.5% 8.9% 16.3% 15.2%
Indirect obstetric causes 28.3% 16.3% 22.2% 20.9% 30.3%
Postpartum complications 10.0% 4.1% 13.3% 9.3% 9.1%
Infections 1.7% 0.0% 6.7% 2.3% 18.2%
Hemorrhage 16.7% 6.1% 2.2% 9.3% 3.0%
Obstructed labor
Total 60 49 45 43 33

Source: Anuarios de Demografia y Estadisticas Vitales (Instituto
Nacional de Estadisticas, Ministry of Health, Civil Registrar).
Figures for 2001, 2002 and 2003 from the Departamento de
Estadisticas e Informacion, Ministry of Health.

Table 3.1 Maternal Deaths According to Age. Chile 1994-2003 (number)

Age Group 1994 1995 1996 1997 1998

10 to 14 years 1
15 to 19 years 7 5 7 3 3
20 to 24 years 16 17 12 13 7
25 to 29 years 20 19 6 18 13
30 to 34 years 11 15 19 14 15
35 to 39 years 11 18 12 9 12
40 to 44 years 8 10 7 4 4
45 years and over 1 1
Total 73 86 63 61 55

Age Group 1999 2000 2001 2002 2003

10 to 14 years
15 to 19 years 3 4 7 4 3
20 to 24 years 11 10 7 9 3
25 to 29 years 9 11 3 13 5
30 to 34 years 15 10 11 5 10
35 to 39 years 12 12 15 9 8
40 to 44 years 10 2 2 3 4
45 years and over
Total 60 49 45 43 33

Source: Anuarios de Demografia y Estadisticas Vitales (Instituto
Nacional de Estadisticas, Ministry of Health, Civil Registrar).
Figures for 2001, 2002 and 2003 from the Departamento de
Estadisticas e Informacion, Ministry of Health.

Table 3.2 Maternal Deaths According to Age. Chile 1994-2003 (rate, per
100,000 live births)

Age Group 1994 1995 1996 1997 1998

10 to 14 years 96.8
15 to 19 years 18.4 13.2 18.1 7.6 7.4
20 to 24 years 21.5 23.7 17.2 19.6 11.1
25 to 29 years 27.2 27.5 8.9 27.3 19.9
30 to 34 years 20.1 28.0 35.4 26.7 28.9
35 to 39 years 42.5 68.6 44.0 32.4 42.7
40 to 44 years 133.8 161.6 111.3 62.4 61.1
45 years and over 331.1 302.1
Total 26.67 32.34 23.79 23.47 21.39

Age Group 1999 2000 2001 2002 2003

10 to 14 years
15 to 19 years 7.6 10.2 18.1 11.0 8.9
20 to 24 years 18.6 17.5 12.5 16.2 5.5
25 to 29 years 14.0 17.2 4.9 22.1 8.9
30 to 34 years 29.4 19.7 21.7 10.1 19.8
35 to 39 years 41.8 40.7 49.8 30.6 27.0
40 to 44 years 149.3 28.1 27.0 38.4 49.5
45 years and over
Total 23.94 19.69 18.28 17.99 14.07

Source: Anuarios de Demografia y Estadisticas Vitales (Instituto
Nacional de Estadisticas, Ministry of Health, Civil Registrar).
Figures for 2001, 2002 and 2003 from the Departamento de
Estadisticas e Informacion, Ministry of Health.

Table 3.3 Maternal Deaths According to Age. Chile 1994-2003
(distribution by percentage)

Age Group 1994 1995 1996 1997 1998

10 to 14 years 1.2%
15 to 19 years 9.6% 5.8% 11.1% 4.9% 5.5%
20 to 24 years 21.9% 19.8% 19.0% 21.3% 12.7%
25 to 29 years 27.4% 22.1% 9.5% 29.5% 23.6%
30 to 34 years 15.1% 17.4% 30.2% 23.0% 27.3%
35 to 39 years 15.1% 20.9% 19.0% 14.8% 21.8%
40 to 44 years 11.0% 11.6% 11.1% 6.6% 7.3%
45 years and over 1.2% 1.8%
Total 73 86 63 61 55

Age Group 1999 2000 2001 2002 2003

10 to 14 years
15 to 19 years 5.0% 8.2% 15.6% 9.3% 9.1%
20 to 24 years 18.3% 20.4% 15.6% 20.9% 9.1%
25 to 29 years 15.0% 22.4% 6.7% 30.2% 15.2%
30 to 34 years 25.0% 20.4% 24.4% 11.6% 30.3%
35 to 39 years 20.0% 24.5% 33.3% 20.9% 24.2%
40 to 44 years 16.7% 4.1% 4.4% 7.0% 12.1%
45 years and over
Total 60 49 45 43 33

Source: Anuarios de Demografia y Estadisticas Vitales (Instituto
Nacional de Estadisticas, Ministry of Health, Civil Registrar).
Figures for 2001, 2002 and 2003 from the Departamento de
Estadisticas e Informacion, Ministry of Health.
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Title Annotation:MATERNAL MORTALITY: Women's Lives in the Balance
Author:Kesten, Camila Maturana; Mora, Fanny Berlagoscky
Publication:Women's Health Journal
Article Type:Report
Geographic Code:1USA
Date:Jul 1, 2007
Words:12055
Previous Article:Maternal mortality prevention in Chiapas, Mexico: the impact of decentralization, change in ruling political parties and gender.
Next Article:Associated social, economic and political factors.
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